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Revision TKR Wberry knee is up<

Oh dear, oh dear, wberry, what a shame. But if you look at the other knee, the patella is in a similar angle to the operated one. So it's more been a case of unfortunate happen-stance so far as I can see. I know it doesn't help you but it's an explanation of sorts. as honest as your surgeon has been, I would definitely go with the surgeon who does lots of revisions as he will be more likely to get it right!
 
Oh my.....I'm so sorry to hear this!!! But, I'm very impressed with the honesty of your surgeon. Very, very good.

However, because this is not going to be a "routine" fix, I think you should go with a different surgeon.....a revisionist. My recommendation would be to get two second opinions....one from the surgeon in Wichita and another from one of the surgeons at Dickson-Diveley. I think it will be easier to decide the next step if you have a couple of reviews of your case. I know you want this fixed like...NOW. But it is important that you are with the best doctor possible. Don't be in a rush and get as much information as you can before proceeding.
 
Sorry to hear this about your knee, you are fortunate to have an OS who is 100% upfront with you. I agree with Jamie, another opinion is in order.
Sending you positive thoughts,
 
Since the OS is already sharing with the Doctor in Wichita, do you think I could ask him to share with the on in Kansas City. It would save me a bunch of leg work getting medical records and films to him also. Or do you think I should just do the other second opinion myself.


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You can go ahead and have the OS's office send your records to the OS in Kanas City, or if you are more comfortable collect the records yourself and send them to Kansas City.
Good Luck,
 
It's okay to get copies of your records, but quite frankly any of the doctors at Dickson-Diveley will take all their own images when you go see them. I'm not sure it's really necessary to have previous records. Your knee will speak for itself. Why don't you call Dickson-Diveley and ask what they prefer.
 
Already did that. The lady I talked to said they needed copies of the records.


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Whoops....you're sooo ahead of me. :thumb:

Then obviously they do want them. With my knee they didn't care. But it was a completely different situation. Glad you called.
 
When I went to Dickson-Diveley, it was a second opinion since the guy in Wichita (not the one you're going to) was not helping. They did want my records but also took their own images when I got there. They used the old records to compare with the new ones they took. I think you are doing the right thing by getting at least two additional opinions -- you definitely want things done right this time. Do you have appointments in either Wichita or KC yet?

Roxie
 
Faxed the request over this morning. I wanted to wait until after this last appointment so i could make sure the OS last entries had been made. I asked for all entries, films, and PT notes starting from the first of the year. That way I get all the preliminary stuff too. Not sure if I am getting a disc or paper copies.
Whew @Kansas Teacher you had me worried for a second. Yes @Jamie I thought the same, but they wanted them. So I got with patient records last week and they sent me the form i had to sign. Dickenson-Diveley also entered my info in their system so once I got them the records. I was curious about the comment the receptionist gave about they review the records first to determine if they want to take on my case. Of course this might be a standard line, I was talking to a receptionist not the doctor. A co-worker is having his redone and he spoke to me about the head or orthopedics at KU medical Hospital in KC. I checked him out and he was mostly a upper extremities and hand specialist.
@skigirl, I understand you had a new spacer put in, would love to get your take on what it was like. My hope is I can possibly exercise to strengthen prior to the redo in hope I will have a better recovery than last time. Remember my quads started out shot due to a year in the offloaded brace. But I could use advice on what i should and shouldn't be doing in this interim. Is there a good revision article on the forum?

I am trying to shift gears to be more positive, like I am finally going to get this fixed instead of, here we go again.
A positive attitude can help create a positive outcome. I asked my doctor if there was anything i did or didn't do to cause this. He said he had no explanation why I loosened or the patella issue. It just happens to some patients, but usually not this soon. I am wondering and will ask this of the other OS, if I loosen once will it happen again. I am hoping than perhaps we got the wrong size spacer in the first place and because my knee was already messed up by the brace it made sizing the spacer a challenge.

So @Jamie am i supposed to start a new pre op thread?
 
Last edited by a moderator:
wberry said:
I was curious about the comment the receptionist gave about they review the records first to determine if they want to take on my case. Of course this might be a standard line, I was talking to a receptionist not the doctor.
Click to expand...
This was the standard practice for all 3 of my second opinions.
For your TKR to loosen this early usually indicates poor technique in applying the bone cement.
Good luck,
 
Hmm, is this always the case? the loosening he mentioned was in the degree of give. he said it was 2mm at surgery and he checked, now it is much much more. He basically moved the knee from side to side after consulting the operations notes. Then up and down and forward and back. If this is a cement issue, do I need a re-gluing?
 
Good for you with the positive attitude, @wberry . I believe too that it makes a difference. Sorry I worried you! I truly have only heard good things about the guy you're seeing in Wichita. Do you know who you'll be seeing at Dickson-Diveley yet?

While I know it doesn't feel this way, I truly feel you are fortunate that the problem is being identified this early. No sense in wasting anymore time with a situation that isn't going to improve.

Just went through a drive through with my husband after hitting the gym (15 minutes on the recumbent -- felt good) and the gal in the window was around my age. She looked down in the car and said, "Oh, another knee replacement recovering, I see." We chatted a bit and she said she had one knee done two years ago and was doing well but now had to have the other one done. She was up on her feet working and it's always good to hear those success stories -- even in unexpected places! You will be one of them too, @wberry.
 
wberry said:
If this is a cement issue, do I need a re-gluing?
Click to expand...
You would need a new implant, the bone surface and the current implant surface will not hold, and you would be right back where you are now. You won't know until they get in there and take a look. Sounds like your ligaments loosened up?
You might want to save these questions to ask the surgeons you are consulting for answers about your knee. When they examine you they will have a better idea of what is happening.
 
@Kansas Teacher, I asked to see Dr. Scott Wingerter, from your recommendation at Dickson-Diveley.
In Wichita i plan to see Dr. Paul Pappademos at Advanced Orthopedics Associates, but I could see anyone in that group, they have several revision folks. I will of course ask if there is a better surgeon in their group when I see them. I may have to pay several co-pays before I find who I like to do the work. Only sad part is I may loose my black knee:sigh:. O well as long as it is a good knee and has good longevity. I would prefer for this to be my last knee ever on this leg.
@Pumpkln, o my, hmmm, well guess i can't be helped. I will be ready for the worst case just in case.
I will type up a list and run it through the forum to get all the feedback, i'm sure you folks will guide me strait.
 
"Loosening" has two meanings, as far as I understand it. If the cement is loose--that is usually from the surgeon applying it improperly. It should not loosen in a year. It is hard to get the cement out and usually you need an entire revision since the knee will have to be resurfaced to get rid of the old cement.

I had a loose knee---You could pull my tibia forward. My surgeon told me that 2-4 was acceptable--mine was 6 degrees. I did not notice it at first--but my pt did right away. I began to have pain because I had adhesions which formed in the knee----partly because of the motion from the loose knee. So, I had an open lysis of adhesions---which means they opened my knee along the old scar and removed extensive scar tissue--or adhesions.

My doc was very open with me (my husband is a doctor, so we won't be suing any doctors in our lifetime!!") that the spacer size is based on experience and subjection. He told me that is he had known how limber I am, he would have used a larger spacer---he used the smaller one to give me greater rom. So, while the knee was open, he put in a size larger spacer as well.

The first question he asked me on my 3 week visit--even before we got into the room--"Is your knee more stable".

The short answer is yes, it is. I noticed it from the first time that I stood up on it. I stayed in the hospital for one night--at my surgeon's insistence---I could easily have gone home. I had some pain, but nothing like a tkr. I took Percoset every four hours--5mg/325, which is not a high dose. I think I took the Percs for three or four days and then switched to tramadol. I drove myself to pt on day 7.

My recovery was long because of the extensive adhesions. My pt did almost nothing for 3 weeks--just gentle heel slides, massage and some table exercises--quad sets, leg lifts. My muscles were still quite strong, although there is always a loss after surgery.

I started simple exercise after 4 weeks--but did not do any serious work until 8 weeks. My doctor cautioned me several times that if I exercised a swollen, hot, inflamed knee I would cause more adhesions to form. I was chafing at the bit--but my pt insisted that we take it slow. He said, if the adhesions return at least we will know that we did everything we could to prevent them from forming.

I am now three years out from that surgery----I do have some adhesions but nothing to the degree of before surgery. my rom? 145. My knee is very stable. I never even think of it very much.

There is no definitive article on revisions because revisions are so different---one from infection, one from a mal aligned implant, etc, etc.

I did not have anywhere near the amount of pain that I had from the tkr---I think it was three or four days. I think I took the tramadol for a week or so after that. I did have a long rehab, to prevent the reforming of adhesions.l

I like to be in control of my body too, but this is a time when you are going to have to sit back, find out what the problem is and then trust someone to fix it for you. Most recoveries from revisions are less than from the original knee, and I think the rehab goes faster. Although I was sick of rehabbing and my attitude sucked at first!!!! When we know what you are dealing with, we will try to find a few members whose revisions were from similar reasons, that is the best info that you can get. Kelly
 
@wberry , I honestly don't think you'll go wrong with either of these surgeons -- it will just be a matter of choosing the one you feel most comfortable with. I'll look forward to hearing what they both recommend and, even more so, will look forward to seeing you on the road to full recovery!

Roxie
 
As so do I. I know it's a mess and you did not want to do it. But we have to do what best for us,so we can take dare of family.

I know what is to set wait and be anxious. It's tore me up and made me a nervous wreck...

But I know once I and same goes for you get the opinion we will be alright. And both be at peace. Xxx


FaithMitchmommy
PKR December.1,2014
TKREV MARCH.2,2015
 
My loosening seems to be more along the line of ligaments i think, in other words the amount of play in the joint is increasing beyond what he felt it should be to a significant degree. So my question is, does that translate into a revision or just a new spacer? Like you said @skigirl, I have more give in my knee now than I did following the operation. So if the issue is only that, it may only need a realignment of the patella, and a new spacer. He mentioned something about the upper component possibly needing to be replaced, but I am not sure if that was because of the alignment issue or what. @Josephine, yes, the caps look the same, but in my case the operative one is actually grinding across the upper prosthetic on the side, so much so, it is catching on each step. the result is the sharp pain i feel and the continued inflammation. is a large band filled with fluid on the side of the knee where the patella is catching and rubbing.

I would imaging @Pumpkln that if the prosthetic cement was loose, he would have said that's why I have the give. Are you saying the give is not because of the increase space and the plate now being to small, or that the reason for the give side to side is the prosthetic shifting where it goes into the bone? The idea of taking the entire thing out worries me. Is there some way they can tell through xrays or and MRI or CT scan if the cement is loose?

I am just patiently waiting on the records and a call about my appointment in Wichita, the OS office is supposed to be setting that one up. I will set up the one in Kansas City myself once i send them the records I requested. This is all coming at a really bad time for me. I may have to cancel a photography contract job depending on when the surgery is scheduled. What ever happens, i need to do it this year, thus it will be covered 100% due to my deductibles all being exhausted from the surgery, now everything is 100%
 
Waiting is the worst part. I hope you hear about your appointment very soon and it doesn't take too long to get in.

Roxie
 
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